Objective: Minimally invasive multivessel coronary bypass performed through a left anterior minithoracotomy may be associated with early postoperative respiratory events related to thoracotomy, one-lung ventilation, and perioperative ventilatory management. This study aimed to describe the early postoperative pulmonary complication profile in our center and to report the use of selective postoperative non-invasive mechanical ventilation (NIMV) in routine clinical practice. Method: This single-center retrospective descriptive study included 77 consecutive patients who underwent minimally invasive on-pump multivessel coronary bypass surgery through a left anterior mini-thoracotomy between January 2022 and December 2024. Patients were evaluated for early postoperative pulmonary complications documented in the clinical record and chest radiography, including atelectatic changes, pleural effusion, pneumonia, decreased partial oxygen pressure (PaO2), and blunting of the costophrenic angle. Preoperative spirometry was obtained when clinically feasible. Results: Seventy-seven patients (44–79 years; mean age 58.2 years) were included. Preoperative spirometry was available in 51 patients. Five patients required postoperative NIMV because of radiographic and/or oxygenation findings during follow-up; in two of these patients, intermittent ward NIMV was administered for SpO2 <92% and PaO2 <70 mmHg, with subsequent improvement in oxygen saturation to >94% after NIMV sessions and mobilization. Postoperative pneumonia occurred in one patient and pleural effusion in two patients; no thoracentesis was required. Mean room-air discharge values were acceptable at cohort level (Table 5), with PaO2 99 mmHg, PaCO2 34 mmHg, and SpO2 94%. Conclusion: In this selected retrospective cohort, early postoperative pulmonary complications after minimally invasive multivessel bypass surgery were infrequent and were managed predominantly with conservative treatment; selective NIMV was used in a small subset of patients as rescue support. The present data support feasibility reporting only and do not establish NIMV efficacy. Prospective comparative studies with standardized postoperative pulmonary assessments are needed.
